Factors associated with tuberculosis contact tracing from the perspective of patients: a cross-sectional survey across three districts in Ghana

BACKGROUND: In Ghana, tuberculosis (TB) case detection remains suboptimal, with only 29-34% of estimated TB cases detected, well below the African regional average of 47% and the World Health Organization (WHO) target of 70%. Contact tracing is an important strategy for identifying exposed contacts and potentially undiagnosed TB cases, thereby supporting early diagnosis and interruption of transmission. This study examined patient-reported factors associated with successful TB contact tracing in three selected districts across three regions in Ghana. METHODS: This study used an analytical cross-sectional study design. A systematic sampling technique was used to recruit TB patients aged 18 years and above from TB treatment registers. Data was collected using a structured interviewer-administered questionnaire by trained research assistants. Descriptive statistics were computed, and logistic regression analysis was used to determine factors associated with contact tracing from the patient's perspective. Variables with log-likelihood ratio p-value ≤ 0.2 in bivariable analysis were included in multivariable models. Statistical significance was set at p < 0.05. RESULTS: A total of 316 tuberculosis patients were included, with a median age of 45 years (IQR: 35-56), and 29.8% aged ≥ 55 years. Overall, 70.3% (222/316) of patients had their contacts successfully traced, while 29.7% (94/316) did not have their contacts traced. Factors independently associated with successful contact tracing included having at least secondary education (aOR = 4.04; 95% CI: 1.78-9.20; p = 0.001), perceived influence of social stigma (aOR = 3.14; 95% CI: 1.84-5.34; p < 0.001), willingness to participate in contact tracing (aOR = 8.14; 95% CI: 1.55-42.74; p = 0.013), perceived access to a health facility (aOR = 4.01; 95% CI: 1.32-12.17; p = 0.014) and perceived religious beliefs (aOR = 5.47; 95% CI: 3.06-9.76; p < 0.001). Conversely, patients residing in Ho Municipality were significantly less likely to have their contacts traced compared to those in the Achiase District (aOR = 0.04; 95% CI: 0.00-0.67; p = 0.025). Given the perception-based measurement of several explanatory variables, these findings should be interpreted cautiously. CONCLUSION: TB contact tracing in the study setting was moderately high but remains suboptimal. The findings suggest that successful contact tracing is associated with educational level, district of residence, willingness to participate, and patient-reported perceptions of social stigma, health facility access and religious beliefs. Improving TB contact tracing requires a comprehensive, patient-centered approach to address implementation gaps.